Osteochondral plug graft trimming device and method

ABSTRACT

A device for trimming an osteochondral plug graft to an implantable configuration, comprises a blade assembly terminating in a configured leading cutting blade and a plug graft housing comprising a substantially longitudinal holding sleeve having a bore and oriented complementarily to the longitudinal structure of the blade assembly to receive the longitudinal structure within the sleeve bore with the assembly cutting blade in close tolerance along an inner bore surface of the longitudinal housing structure.

BACKGROUND OF THE INVENTION

This invention relates to an osteochondral plug graft trimming deviceand method.

Human joint surfaces are covered by articular cartilage that provides aresilient, durable surface with low friction. Cartilage is an avasculartissue that has a small number of chondrocytes encapsulated within anextensive extracellular matrix. The cartilage acts to distributemechanical forces and to protect subchondral bone. The knee is aparticular instance of a cartilage surfaced (the condyle) bone area. Theknee comprises three bones—the femur, tibia, and patella that are heldin place by various ligaments. Corresponding chondral areas of the femurand the tibia form a hinge joint and the patella protects the joint.Portions of the chondral areas as well as the underside of the patellaare covered with an articular cartilage that allows the femur and thetibia to smoothly glide against each other without causing damage.

Damage to the articular cartilage, subchondral bone or both can resultfrom traumatic injury or a disease state. For example, articularcartilage in the knee can tear due to traumatic injury as with athletesand degenerative processes as with older patients. The knee cartilagedoes not heal well due to lack of nerves, blood vessels and a lymphaticsystem. Hyaline cartilage in particular has a limited capacity forrepair and lesions in this material without intervention, can formrepair tissue lacking the biomechanical properties of normal cartilage.

A number of procedures are used to treat damaged articular cartilage.Currently, the most widely used procedure involves lavage, arthroscopicdebridement and repair stimulation. Repair stimulation is conducted bydrilling, abrasion arthroplasty or microfracture. The goal of thisprocedure is to penetrate into subchondral bone to induce bleeding andfibrin clot formation. This promotes initial repair. However, theresulting formed tissue is often fibrous in nature and lacks thedurability of normal cartilage.

Osteochondral grafting has been used to repair chondral damage and toreplace damaged articular cartilage and subchondral bone. First in thisprocedure, cartilage and bone tissue of a defect site are removed byrouting to create a bore of a precise cylindrical geometry. Then acylindrical cartilage and subchondral bone plug graft is harvested in amatching geometry. The harvest is typically from another body region ofless strain. The plug graft can be harvested from a recipient source(autograft) or from another suitable human or other animal donor(allograft). The harvested plug graft is then implanted into the bore ofthe routed defect site. Healing of the graft bone to host bone resultsin fixation of the plug graft to surrounding host region.

Surface characteristics of the plug graft are critical. For a successfulprocedure, surface of the transplanted graft must have the same contouras the excised osteochondral tissue. If the contour is not a correctmatch, a repaired articular surface is at risk for further damage.

Also, osteochondral grafts are typically harvested in a cylindrical plugform. However, a cylindrical shape does not pack well into irregularlyshaped defects. Further, cylindrical plug grafts have a propensity torotate. This results in poor integration of the plug graft withsurrounding host tissue.

There is a need for a device and method to overcome post implantationmotion, graft surface mismatch and host tissue integration failure.

BRIEF DESCRIPTION OF THE INVENTION

The invention relates to a device and method that overcome host tissueintegration failure and post implantation motion. In a first embodiment,the invention is a device for trimming an osteochondral plug graft to animplantable configuration, comprising: a longitudinal blade terminatingin a configured leading cutting edge; and a substantially longitudinalplug graft holding sleeve having a bore and oriented to coaxiallyreceive the longitudinal blade within the sleeve bore with the blade inclose tolerance along an inner bore surface of the holding sleeve.

In another embodiment of the invention, a method for repairing articularcartilage in a patient comprises: loading an osteochondral plug graftinto a longitudinal holding sleeve so that the plug graft is biasedagainst a surface of the holding sleeve.

Another embodiment is a kit for a surgical procedure, comprising: aplurality of longitudinal cutting blades each terminating in adifferently sized or configured leading cutting blade; and alongitudinal holding sleeve having a bore to receive a plug graft.

Another embodiment is a device for trimming an osteochondral plug graftto an implantable configuration, comprising: a housing with a housingthrough bore; a support altar with a pedestal partially extending withinthe housing through bore and terminating in a flat impact surfaceparallel to a traverse axis of the housing through bore; a guideslidably fitted to the housing and a guide through bore aligned with thehousing through bore to form a continuous passageway; a plug holdingsleeve nestled within the housing through bore to hold a plug graft inan shearable orientation aligned within the continuous passageway; andan integral adjustable assembly to access and pare the osteochondralplug graft to a selected configuration.

BRIEF DESCRIPTION OF THE DRAWING

FIG. 1 is a perspective, exploded view of a first device of theinvention;

FIG. 2 and FIG. 3 are perspective views of the device of FIG. 1;

FIG. 4, FIG. 5 and FIG. 6 are cut away side elevations of the FIG. 1device;

FIG. 7 is a perspective, exploded view of a second device of theinvention;

FIG. 8, FIG. 9, FIG. 10 and FIG. 15 are perspective views of parts ofthe device of FIG. 7;

FIG. 11, FIG. 12, FIG. 13 and FIG. 14 are cut away side elevations ofparts of the FIG. 1 device; and

FIG. 16 and FIG. 17 are schematic cut away elevations of the FIG. 15part in operation.

DETAILED DESCRIPTION OF THE INVENTION

An embodiment of the invention provides a device and method for trimmingboth cross section and length of an osteochondral plug graft. Anallograft or autograft plug can be harvested in an oversize or randomconfiguration and shipped oversized to a location of implanting such asto an operating room. At the operating room, the graft can be trimmeddown to the appropriate size as needed for an osteochondral implantationby using the device and method of the invention. For example, a 16 mmside dimension round plug can be harvested from a donor and stored in atissue bank. Then at an operating room, the plug can be trimmed an 8 mm,10 mm or 12 mm, round or square shape, as appropriate for an instantimplanting.

A feature of the invention is to use an apparatus that is somewhat likea matched punch and die set with a support for the to-be-shapedmaterial. This particular type of apparatus is appropriate for cuttingthe very particular physical characteristics of purified allograft bone.In the invention, the length of an osteochondral graft that has acartilage portion overlying an end of a condyle portion can be trimmedto a size for implanting in a patient. For example, a graft as initiallyreceived is approximately 20 millimeters in length. It is desired to cutthe plug to 10 millimeters in length and 10 millimeters in width tocorrespond to a configuration of a recipient socket formed in a patientsdefect area.

One trimming device according to the invention comprises a stationaryaltar-shaped base, a housing, an impactor and an upper guide with ahorizontal upper plate. The housing includes a horizontal base plate andthe impactor includes an upper cutting plate. The housing can include abore and at least two vertical receivers. The guide can include at leasttwo posts complementary to the receivers for connecting the guide to thehousing. A sleeve has the same cross section as the housing bore so thatit can sit inside the bore. The top surface of the sleeve is flat andthe top surface and that of the housing outboard of the opening aresubstantially flush.

The invention advantageously provides an increase in supply of availableosteochondral plug grafts by providing a device and method to usecustomizable and storable grafts. The invention reduces operating roomtime for perpendicular walled trimming. The plugs can be trimmed to anappropriate length and an appropriate cross section with a minimumhandling of the plug.

Features of the invention will become apparent from the drawings andfollowing detailed discussion, which by way of example withoutlimitation describe preferred embodiments of the invention.

A First Instrument Embodiment

FIGS. 1 to 6 show a preferred plug graft trimmer 10. FIG. 1 is anexploded perspective view of graft trimmer 10, FIG. 2. is a perspectiveview of the trimmer 10 in a poised position and FIG. 3 is a perspectiveview of the trimmer 10 in an impacted position. The FIGS. 1 to 3 showimpactor 12, blade assembly 14, plug graft housing 16 and housing sleeve18.

In the FIGS. 1 to 6, impactor 12 includes handle surface 20 and stem 22and thread 24. Thread 24 has complementary threaded fit to inner thread26 within inner blade sleeve 28 of blade assembly 14. Blade assemblyfurther includes blade 30 that extends from lower base 32 of the bladeassembly 14. Plug graft housing 16 includes plug holding sleeve 34 andbase 36.

In a procedure upon arrival of osteochondral plug graft 38 from a tissuebank or directly from a donor, it is loaded into plug holding sleeve 34of plug graft housing 16 as illustrated in FIG. 1. A sized plug holdingsleeve 34 is selected to hold the loaded osteochondral plug graft 38 ina snug relationship, biased against inside faces 44 of the holdingsleeve 34. In the embodiment shown, vertical slots 40 of the plugholding sleeve 34 enable a suitable biased fit against inside faces 44to facilitate paring of the osteochondral plug graft as hereinafterdescribed. It should be noted that the osteochondral plug graft 38 isillustrated as a trapezoid figure with a square cross-section. However,the osteochondral plug graft 38 can be any three dimensionalconfiguration including but not limited to a cylinder, cube, trapezoidand a truncated prism or cylinder. Similarly, the blade 30 and plugholding sleeve 34 can be selected from a plurality of configurations andsizes to facilitate the shaping of any desired implantable plug graft.For example, if a osteochondral plug recipient socket in a patient is soconfigured as to admit of a cylindrical plug graft, then blade 30 andplug holding sleeve 34 can be selected to provide an appropriatecylindrical implantable plug graft.

After emplacement of the osteochondral plug graft 38 within the plugholding sleeve 34, the plug graft housing 16 is placed within housingsleeve 18 as shown in FIG. 2 and FIG. 4. Impactor 12 is threaded toblade assembly 14 via threads 24 and 26. The threaded impactor 12 andblade assembly 14 are placed over plug graft housing 16 within housingsleeve 18 as illustrated in FIGS. 2 to 6. As the threaded impactor 12and blade assembly 14 are emplaced, inside faces 44 of plug holdingsleeve 34 guide outside surfaces 46 of blade 30 through a height of theblade 30 to rest on top 42 of the osteochondral plug graft 38. Then aforce is applied to handle surface 20 of the impactor 12 either bymanual force or by impact of a tool such as a mallet, to drive theimpactor and correspondingly the threaded blade assembly 14substantially along side the inside surfaces 44 of the plug holdingsleeve 34. As noted above, plug holding sleeve 34 is size to hold theloaded osteochondral plug graft 38 in a snug relationship, constrainedagainst inside faces 44 of the holding sleeve 34. By constrained ismeant that the graft 38 is held by an imposed stricture of the faces 44.Hence, as the blade 30 is impacted downwardly against biasedosteochondral plug graft 38, the beveled cutting edge of blade 30 passesalong the graft 38 in a shearing manner to pare the surface of the graft38 to a desired size. “Pare” in this application means to diminish orreduce by shaving or trimming a thin slice of osteochondral plug graftclose to its surface.

After the blade 30 has been impacted through the osteochondral plugsurface as shown in FIG. 6, the blade assembly 14 is withdrawn from thehousing sleeve 18 and is disassembled from impactor 12. The paredosteochondral plug graft 38 is ejected from the blade 30 by pushing onthe graft 38. The plug 38 is now sized and configured for implantinginto a recipient socket of a patient.

A Second Instrument Embodiment

FIG. 7 is an exploded perspective view of an adjustable osteochondralplug graft trimmer 110 according to a next preferred embodiment. Theadjustable plug graft trimmer 110 comprises support altar 112, housing114 supported on the base 116 of altar 112 and guide 118.

FIG. 13 and FIG. 14 are side elevation views showing mating of housing114 to support altar 112 as hereinafter described. Referring to FIG. 7and FIGS. 15 and 16, altar 12 includes base 116 and an elevatingelongated pedestal 120. Elevated elongated pedestal 120 is verticallyoriented from base 16 and terminates in a flat impact surface 122 at adistal end from the base 16.

In FIG. 7 and FIGS. 11 through 14, housing 114 comprises a structurethat includes a bore 124 vertically traversing housing 114 and shaped toaccommodate elongated pedestal 120 in a nested relationship within bore124. Guide 118 is a bridge or table shaped structure with posts 194.Vertical sockets 128 of housing 114 are channels that receivecomplementary posts 194 of guide 118 as shown in FIG. 13 to form afitting to secure housing 114 and guide 118 as shown in FIGS. 13 and 14.Guide 118 has a bore 130 that forms a continuous passageway with bore124 of housing 114 when the guide 118 and housing 114 are secured toeach other as shown in FIGS. 8, 9 and 10. FIG. 7 also shows aninsertable base plate 134 and insertable blade plate 138. Housing 114has slot 132 that horizontally traverses through the bore 124 of thehousing 114 for receiving base plate 134 and guide 118 has slot 136 thathorizontally traverses through bore 130 for receiving blade plate 138 ashereinafter described.

Still further, FIG. 7 shows blade 142 and length trimmer 144. Blade 142is shown as a single size but can be provided in a multiplicity of sizesto accommodate a selected implant size for a patient. Further, plugholding sleeve 140 is shown in FIG. 7, configured to nest into housingbore 124. Plug holding sleeve 140 comprises a rectangular shape channel198 configured to receive a plug graft 184. While the “blank” plug graftis shown in a cylinder shape, the plug graft can be any useable shapeincluding cubic, trapezoid, parallelogram and the like. Also, while theholding sleeve 140 is shown in this embodiment as having a square crosssection so as to carve a square cross section plug graft, the holdingsleeve can be any convenient shape in cross section including, round,oval, square and rectangle to form a corresponding cross sectionalshaped plug graft implant. For example in a procedure, a plug graft 184is harvested in a gross size and is delivered to a surgical site. Forexample, the plug graft 184 can be harvested in an 11.9 mm cross-sectionsize. At the site, the plug graft 184 is positioned within holdingsleeve 140 so that it is constrained against the sleeve 140 inner walls.A blade 142 is selected to pare a close tolerance surface from the pluggraft 184 to provide a required implant size and configuration. Forexample, a blade can be selected of a size to pare 0.01 mm to 0.4 mm ofcross section from the plug, desirably 0.10 mm to 0.3 and preferably0.15 to 0.25 mm to provide an about 9.9 mm, 7.9 mm or 5.9 mm size forimplanting.

Raised lips 200 are provided at boundaries of each opening 188 of theblade plate 134. Each blade 142 has corresponding extensions 202 theinterface with lips of respective openings 188 when a blade 142 isinserted into a respectively sized opening 188 of the plate 134. Thesefeatures permit firm attachment of a selected cutting blade 142 to theplate 134.

Together the arrangement of the channeled cutting blade 142, the holdingsleeve 140 and the surrounding surface of the guide 118 provide a punchand die set type of functionality. The matched punch and die set analogof this invention comprises the channeled cutting blade 142, which matesslidably within the holding sleeve 140, which has a substantiallyidentical cross section shape. An outer support is provided via theguide 118, which is shaped such that its bore 130 is substantially thesame cross-section as that of the holding sleeve 140 but displaceduniformly outward such that the cutting blade 142 slides snugly butsmoothly into and out of a space between the holding sleeve 140 andguide bore 130. The blade 142 can comprises leading beveled cutting edge204 and in some embodiments, points, all with sharpened cutting edgesconfigured so as to slice cleanly into a bone from which the implant isto be cut.

The holding sleeve located on the stationary base plate slidablyreceives the channeled blade 142 attached to the horizontal upper plate134. In operation, a segment of bone to be shaped is placed withinholding sleeve 140 and the sleeve is inserted into guide bore 130.Downward pressure is applied to the guide 118 so that the blade 142 isdriven through a plug graft blank to form a dimension of the plug graft184.

The combination of vertical guide posts 194 and complementary receivers196 on the housing 114 function to keep the path traveled by the cuttingblade 142 cutting blade substantially parallel to a longitudinal axis ofthe holding sleeve 140, which in the preferred embodiment is vertical.

The channeled cutting blade 142, holding sleeve 140 and guide 118,collectively form a complementary cutting set that represents any numberof different embodiment combinations sizes and configurations. Matchedcutting sets of a cutting blades, for example with cylindrical shape,complementary cylindrical holding sleeve and guide with a centralcylindrical cross sectional opening form a slot just the width of achanneled cylindrical blade, upon which a donor bone is placed. Thechanneled cylindrical cutting blade is forced through the donor bone andover the holding sleeve to form a cylindrical plug graft.

The sleeve 140 with the plug graft 184 is then placed in housing 114with base plate 138 assembled into housing 114. Blade plate 134 isassembled to impact guide 118 and an appropriate sized blade 142 isattached to blade plate 134. Impact guide 118 along with blade plate 134and blade 142 is then positioned with sleeve 140 over housing 114. Astandard surgical hammer is applied to guide 118 to tap the guide 118through the height of the housing 114 to cause blade 142 to shear alongan outer plug graft surface of the constrained plug graft 184. The blade142 pares the plug graft 184 to the selected first cross section size.

Length trimmer 144 is described in detail with reference to FIG. 7, FIG.9 and FIG. 15. FIG. 7 and FIG. 9 show that length trimmer 144 can befitted within guide bore 130 of guide 118 and driven with the guide 18as the guide 118 is advanced along the housing receivers 196 into aconforming fit with housing 116. FIG. 15 is an exploded perspectivedetail of length trimmer 144. FIGS. 7, 9 and 15 depict length trimmer144 for trimming a plug graft 184 harvested from an undamaged non-loadbearing area of a patient or recipient or from a donor and sheared intoa first dimension by blade 142. The length trimmer 144 comprises acylindrically-shaped body member 212 having a continuous bore 214 formedfor receiving the plug graft 184. Bore 214 has a rectangularcross-section that can correspond to a cross-section of a plug graftsuch as plug graft 184. One end of the bore 214 serves as an inlet forreceiving the plug graft 84. A transverse cutting slot 216 extendsthrough the body member 212 in a spaced relationship to inlet 218 forcutting the graft, in a manner to be described. An annular flange 220extends from another end 222 (opposite the inlet 218 end) of the bodymember 212. A circumferential groove 224 is formed in the flange 220. Anlongitudinally extending slot 226 is formed through surfaces 230 of thebody member 212, as viewed in the drawing.

Indicia 234 are provided as shown on surface 230 to either side of theslot 226. In the example shown in the drawings, the indicia 228 indicatedistance in millimeters along slot 226. The indicia 228 provide part ofa mechanism for adjusting a position of a plug graft 184 in bore 214.The mechanism includes rod 234 adapted to extend within bore 214. Oneend portion 236 of the rod 234 is externally threaded and another end238 is adapted to be connected in any conventional manner, such as by aset screw to plunger 240. Outer surfaces 242 of two opposed sideportions of rod 234 are flat, and two dowels 244 extend throughcomplementary openings 246 in the body member 112 to engage flatsurfaces 142 of rod 234 to prevent rotation of the rod 234 in the bodymember 212.

A knob 248 has an internally threaded bore (hidden) in threadedengagement with part of the threaded end portion 136 of the rod 234. Twodowels 250 extend through two transverse openings 252 formed in the knob248 and into the groove 254. This secures the knob 248 against axialmovement relative to the body member 212 while permitting rotationalmovement. A pair of magnets 256 is located in corresponding openings 258formed in the end of the body member 212 adjacent an inlet 216 of thebore 214, for reasons to be explained. [PLEASE EXPLAIN.] The lengthtrimmer 144 is shown perspective in an assembled condition in FIG. 15with rod 234 and therefore the plunger 240, in fully extended positionwith the plunger 240 located at the inlet 216 of the bore 214.

The length trimmer 144 can be used to configure a plug graft into anappropriately sized three dimension shape for implanting in a recipientsocket in a condyle surface of a patient. In a procedure to use theadjustable plug trimmer 110, an oversized plug graft 184 is obtainedfrom a tissue bank and is emplaced into the plug holding sleeve 140.FIGS. 11, 12, 13 and 14 are cut away elevation views illustratingplacement and trimming of plug graft 184. FIG. 11 is a front elevationview, cut away to show plug holding sleeve 140 holding a plug graft 184within its bore 186. FIGS. 12, 13 and 14 then show the sleeve 140emplaced into housing 114 with an inserted base plate 134.

An appropriate sized blade 142 is selected and attached to the bladeplate 134. The blade plate 134 with blade 142 is inserted to the impactguide 118 by means of the plate 134, as shown in FIG. 7 as well asperspective views FIGS. 8 to 10 and cut away views of FIGS. 13 and 14.The similarly aligned base plate 138 is emplaced within housing slot 132as shown in FIGS. 7 to 3 and FIGS. 12 to 14. The plate 138 is insertedso that an opening 190 of the plate 138 that corresponds to the selectedopening 188 of the blade plate 134 and bore 192 of blade 142 are allaligned with housing bore 124 to form a continuous passageway. Thehousing 114 is placed onto support altar 112 with elongated pedestal 120extending upwardly within the bore 124 of the housing 114. The graft 184is placed within plug holding sleeve 140 and the sleeve 140 with thegraft 184 is placed onto face 122 of the elongated pedestal 120 withinthe housing bore 124. Elongated pedestal 120 of support altar 112 as theholding sleeve is advanced within housing 114 to a contact position witha plug graft postured on flat surface 122 of pedestal 120 as shown inFIGS. 15 and 16. Then, the impact guide 118 along with the blade plate138 and blade 142 is impacted through the height of housing bore 124,for example by driving with a standard surgical mallet. The drivingmates the impact guide 118 with the housing 24 by inserting posts 194 ofthe impact guide 118 into receivers 196 of the housing 124. Driving theblade through the housing bore 124 pares the plug graft 184 to a desiredfirst cross-sectional dimension. Base plate 138 provides a “cuttingboard” type of function to stabilize a plug 184 for clean cleavage by animpacting blade 142. The plate 138 can be made of a relatively softplastic material to avoid damage to the impacting blade 142. Forexample, the plate 138 can be made from Delrin® plastic, an acetal resinfrom E. I. du Pont de Nemours and Company Corporation Delaware, 1007Market Street, Wilmington, Del. 19898. After shaping the plug 184 withthe blade 142 in a first direction, the impact guide 118 is removed anda base plate opening 190 is aligned with the plug 184 permitting thepedestal 120 to push the plug from the blade 142 to length trimmer 144.

Before use, knob 248 of the length trimmer 144 is rotated in a directionto cause axial movement of rod 234 and therefore plunger 240 to a fullyretracted position, i.e., a position in which the plunger 240 is amaximum distance away from the cutting slot 216. Then thecylindrically-shaped body member 212 of length trimmer 144 is insertedwithin the extending bore 130 of guide 118 as shown in FIG. 16 and FIG.17. Referring to FIG. 16 and FIG. 17, body member 212 interfaces withthe blade plate 134. Length trimmer 144 receives both the lips ofopenings 188 of plate 134 along with interfaced blade extensions 202 toseat the blade 142 end within bore 214. The combined structure of thelength trimmer 144, plate 134 and blade 142 is imposed downwardly ontoaltar base 116 so that elongated pedestal 120 pushes the osteochondralplug 184 from the blade 142 bore 192 into the length trimmer 144.

The length trimmer 144 has length markings (indicia 228) and a cuttingslot 216 for a surgical blade (not shown) to pass through the extractedplug 184. Knob 148 is rotated till a desired length reading isregistered at the indicia 228. Then the length of the plug 184 is cutwith the blade. Again, the knob 248 is rotated until plug 184 is pushedout of the length trimmer 144. The plug 184 is now of a selected crosssection and selected length for implanting.

The invention provides a device to trim an osteochondral plug graft bothin its length and cross section. The invention permits an allograft plugto be harvested in an oversize at a tissue bank and shipped to anoperating room where it can be trimmed to an appropriate size as needfor implantation to a patient. For example, a tissue bank can supply asquare or round harvested osteochondral plug graft in a 16 mm dimension.At the operating room, the plug graft can be trimmed to a required 8 mm,10 mm or 12 mm (square dimension or cylinder diameter) to fit arecipient socket in a patient.

While preferred embodiments of the invention have been described, thepresent invention is capable of variation and modification and thereforeshould not be limited to the precise details of the Examples. Theinvention includes changes and alterations that fall within the purviewof the following claims.

1. A device for trimming an osteochondral plug graft to an implantableconfiguration, comprising: a longitudinal blade terminating in aconfigured leading cutting edge; and a substantially longitudinal pluggraft holding sleeve having a bore and oriented to coaxially receive thelongitudinal blade within the sleeve bore with the blade in closetolerance along an inner bore surface of the holding sleeve.
 2. Thedevice of claim 1, further comprising an osteochondral plug graftcomprising a cartilage layer attached to an underlying body of boneinserted within the plug graft housing for paring by the cutting blade.3. The device of claim 1, wherein the leading cutting edge is configuredin a rectangle, oval, square or circle shape.
 4. The device of claim 1,wherein the holding sleeve bore is configured in a rectangle, oval,square or circle cross sectional shape.
 5. The device of claim 1,comprising an impactor connected to the blade assembly at an endopposite the blade leading cutting edge.
 6. The device of claim 1,wherein the holding sleeve includes open slots traverse to the holdingsleeve bore openings that allow a portion of an inserted osteochondralplug graft to impose outwardly from the holding sleeve bore.
 7. Thedevice of claim 1, further comprising an osteochondral plug graftcomprising a cartilage layer attached to an underlying body of boneinserted within the plug graft housing and wherein the holding sleeveincludes open slots traverse to the holding sleeve bore that allow aportion of the inserted osteochondral plug graft to impose outwardlyfrom the holding sleeve bore for paring by the cutting blade.
 8. Amethod for repairing articular cartilage in a patient, comprising:loading an osteochondral plug graft into a longitudinal holding sleeveso that the plug graft is biased against a surface of the holdingsleeve.
 9. The method of claim 8, comprising ejecting the paredosteochondral plug graft from the holding sleeve for implanting at anarticular cartilage site; and driving a cutting blade along the surfaceof the holding sleeve to pare the osteochondral plug graft to a selectedconfiguration for implanting.
 10. The method of claim 8, comprisingharvesting the osteochondral plug graft from a donor site for loadinginto the holding sleeve.
 11. The method of claim 8, comprising selectinga cutting blade according to a desired configuration for implanting intothe articular cartilage site in the patient.
 12. The method of claim 8,comprising preparing the articular cartilage site for receipt of theosteochondral graft by forming a recipient socket in subchondral bone ofthe site.
 13. The method of claim 8, comprising preparing the articularcartilage site for receipt of the osteochondral graft by forming arecipient socket in subchondral bone of the site and selecting a cuttingblade from a plurality of differently configured cutting blades to forman osteochondral plug graft for fit within the recipient socket.
 14. Themethod of claim 8, wherein the osteochondral plug graft is loaded bysqueezing the plug graft into the holding sleeve so that the plug graftis biased against a surface of the holding sleeve.
 15. The method ofclaim 8, wherein the osteochondral plug graft is loaded by squeezing theplug graft into the holding sleeve so that the plug graft is constrainedagainst a surface of the holding sleeve and through longitudinaltransverse slots of the sleeve to facilitate pairing of the plug graftsurface.
 16. The method of claim 8, further comprising loading the paredplug graft into a bore of a body with bore length indicia, wherein thebody has a longitudinal slot to observe the insertion of the pared pluggraft into the body and slot transversally axial to the body to admit acutting blade to cut the pared plug graft at a length indicated by theinsertion of the plug graft into the body.
 17. A device for trimming anosteochondral plug graft to an implantable configuration, comprising: ahousing with a housing through bore; a support altar with a pedestalpartially extending within the housing through bore and terminating in aflat impact surface parallel to a traverse axis of the housing throughbore; a guide slidably fitted to the housing and a guide through borealigned with the housing through bore to form a continuous passageway; aplug holding sleeve nestled within the housing through bore to hold aplug graft in an shearable orientation aligned within the continuouspassageway; and an integral adjustable assembly to access and pare theosteochondral plug graft to a selected configuration.
 19. The device ofclaim 18, wherein the integral adjustable assembly comprises a selectedchanneled cutting blade poised within the guide bore and having aleading cutting edge configured to pare the plug graft to a desiredshape when the guide with blade is activated to impact the housing andto correspondingly impose the cutting blade along a surface of theosteochondral plug graft positioned against the impact surface of thesupport altar.
 20. The device of claim 19, wherein the cutting bladeleading edge is configured to pare the plug graft to a cross sectionalsquare shape, rectangular shape, round shape or oval shape.